Rare Disease Linked to Dengue Virus Caused Texas Woman's Death

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A woman in Texas who died in 2012 succumbed to a rare blood cell
disease, which was caused by the mosquito-borne dengue virus
infection, according to a report of her case published today.

The case shows that while dengue remains rare in the United
States, vigilance for the disease is important, and health
professionals should be aware of the complications the virus can
cause.

The woman died after her
dengue infection brought on another condition called
hemophagocytic lymphohistiocytosis (HLH), in which white blood
cells build up in the skin, spleen and liver, and destroy other
blood cells. HLH is most frequently associated with Epstein Barr
virus infection, but also has been linked to dengue, according to
the researchers, from the Centers for Disease Control and
Prevention.

The 63-year-old woman was only the third person in the United
States in the past 10 years to become infected by dengue virus
without leaving the country. Other U.S. patients with dengue
fever were infected while traveling to tropical regions, where
the virus is endemic. [ 10
Deadly Diseases That Hopped Across Species ]

Mosquitos capable of transmitting the virus can be found in most
U.S. states, and there have been
recent outbreaks of dengue in Florida, Hawaii and Texas,
after travelers brought the virus home with them.

The woman developed fever, headaches and pain in her leg while
traveling in Santa Fe, New Mexico, in August 2012. After
returning to her home in Texas, she was initially diagnosed with
West Nile virus infection, but later developed serious
blood conditions and liver failure, and died in October 2012, a
few days after doctors diagnosed her with HLH. Dengue virus was
detected in a biopsy of her bone marrow.

Dengue virus infects an estimated 400 million people worldwide
each year. The incidence of dengue in the United States is
unknown, according to the CDC. Early recognition of the infection
and immediate treatment can substantially lower the risk of
death.

There are several possible scenarios that could explain how the
Texas woman became infected with dengue, the report's authors
said. The patient spent almost a month in Santa Fe, a city
generally too elevated for mosquitos to live. However, an
imported mosquito might have survived in the warmer August
climate, and infected the patient, the researchers said.

It is also possible that the patient initially had another
illness and was infected with dengue while en route to Texas,
where the virus is more likely to be found, according to the
report.

Most U.S. cases of dengue occur in the people living in Puerto
Rico, the U.S. Virgin Islands, Samoa and Guam, according to the
CDC. People living in or traveling to areas where a risk for
dengue exists should avoid mosquito bites by using insect
repellent, and staying in residences with air conditioning.